Facet Joint Syndrome

Facet Joint Syndrome

Facet joint syndrome is a condition of the tiny facet joints, which lie behind and between the vertebrae. Facet joints are responsible for the spine’s flexibility and stability. With facet syndrome, these joints become swollen and inflamed, which can lead to back or neck pain, headaches, and limited mobility.

 

What are the facet joints?

 

The human spine has 24 irregular shaped bones called vertebrae. The facet joints connect these bones, with two facet joints between each pair of vertebrae (one on each side). The joints link each vertebra to those below and above it, and they allow the bones to rotate with respect to each other. Like other joints, facet joints have cartilage, which allows for smooth movement.

 

How common is facet joint syndrome?

 

In a recent study, 500 patients with chronic spine pain were evaluated. Researchers evaluated for the prevalence of facet joint pain in accordance with the criteria established by the International Association for the Study of Pain. The researchers found that the prevalence of facet joint pain for patients with chronic neck pain was 55%, and for those with thoracic spine pain, the rate was 42%. In addition, 31% of the patients with lumbar spine pain had facet joint discomfort.

 

What are the symptoms of facet joint syndrome?

 

When the facet joints become irritated, inflamed, or swollen, they cause pain and impingement (pinching) of the nerves that supply the joints. Depending on the location of the facet joint irritation, associated symptoms can include pain radiating down an arm or leg, as well as leg/arm weakness, numbness, and tingling.

 

How is facet joint syndrome diagnosed?

 

To determine if you have facet joint syndrome, the orthopedic surgeon will examine your back, evaluate muscle strength, and take a medical history. To assess for soft tissue and nerve problems, computed tomography and magnetic resonance imaging scans are used. A facet joint block can confirm the diagnosis. This involves injecting an anesthetic into or near the facet joint nerves. If there is pain relief, the doctor can assume facet joint syndrome exists.

 

How is facet joint syndrome treated?

 

Facet joint syndrome is often treated using a combination of non-surgical measures. These include:

 

  • Posture correction – A spinal brace will help assure proper alignment of the spine, which reduces stress on the neck and lower back.

 

  • Physical therapy – To improve strength and flexibility, the therapist teaches the patient certain exercises. Pain relief measures used in therapy include ultrasound, electrical stimulation, and massage.

 

  • Medications – For irritation and inflammation, nonsteroidal anti-inflammatory agents are prescribed. For nerve pain, the doctor may order anticonvulsants and/or antidepressants.

 

  • Facet joint injection (FJI) – To provide symptom relief, the doctor can inject an anesthetic, with or without a corticosteroid, into or on the spinal nerves that supply the facet joints. These injections offer 3-6 months of pain relief.

 

Will I need surgery?

 

When conservative measures fail to provide lasting pain relief, the orthopedic specialist may recommend spine surgery. Surgical options include:

 

  • Laminectomy – Removal of a portion of the vertebral arch to widen the spinal canal, which makes more space for nerves.

 

  • Spinal fusion – This involves fusing (joining) two vertebrae together using bone grafts or substitutes. The graft will bind the bones together to maintain normal disc height.

 

  • Radiofrequency rhizotomy – This procedure involves destroying the facet joint nerves using radiofrequency energy.

 

Resources

 

Manchikanti L, Broswell MV, Singh V, et al. (2004). Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskel Disord, 5, 15.